Treatment satisfaction and metabolic outcome in patients with type 2 diabetes starting insulin: one‐to‐one vs group therapy

Abstract

AbstractThe UK Prospective Diabetes Study (UKPDS) confirmed that intensive therapy resulting in optimal glycaemic control (HbA1C7%) reduces the risk of microvascular complications in patients with type 2 diabetes. The understanding that type 2 diabetes is a progressive disease has resulted in many patients being converted from tablets to insulin following secondary failure of hypoglycaemic agents. Recognising the need for early intervention, increasing numbers of patients are being referred from primary care for initiation of insulin therapy. To cope with this increase in demand, group education insulin starter groups were introduced at our centre in 1999.The aim of this study was to retrospectively compare the one‐year outcome in terms of metabolic and treatment satisfaction parameters for all patients with type 2 diabetes who were converted to insulin conventionally in a one‐to‐one setting with a diabetes specialist nurse (1997–1998) or via group education insulin starter groups (1999–2000).Records of consecutive patients with type 2 diabetes, converted to insulin during 1997–1998 (conventional one‐to‐one group) and 1999–2000 (insulin starter group) were audited for baseline parameters and one‐year follow‐up outcomes. Treatment satisfaction was measured using the Diabetes Treatment Satisfaction Questionnaire (DTSQ).Both conventional one‐to‐one (n=64) and insulin starter group (n=69) therapy were equally matched for age, duration of diabetes and initial weight. Initial glycaemic control was significantly higher with one‐to‐one teaching compared with group therapy (fructosamine 479±99µmol/L vs 439±82µmol/L respectively, p=0.01). At one year, glycaemic control was similar for both groups (one‐to‐one 381±72µmol/L vs insulin starter group 397±76µmol/L, p=NS). Similar numbers of patients in both groups achieved target glycaemic control of <350µmol/L fructosamine. General treatment satisfaction in the insulin starter group setting (30.4±7) was significantly greater than one‐to‐one teaching (26.9±8, p=0.001), out of a maximum score of 36, measured using the DTSQ.In conclusion, conversion to insulin can be successfully achieved through group sessions, with patients reporting greater treatment satisfaction than those receiving one‐to‐one teaching. Copyright © 2003 John Wiley & Sons, Ltd.